In this series of Policy Perspectives, ADVOCACYDENVER is providing synopses of meetings of the Colorado Commission on Medicaid. This edition covers the meeting held on September 17, 2026 at 10am. The Colorado Commission on Medicaid is working toward the goal of creating a sustainable Medicaid program for the state. The Commission will present their final report to the General Assembly and Governor in December.
The Commission continues to seek stakeholder feedback from people who use, provide, pay for, or work in the Medicaid program. If you wish to provide feedback through the long-form survey, click HERE. If you prefer a shorter survey, you can respond HERE.
Agenda & Materials:
The meeting agenda and materials can be found HERE.
Recording of the meeting can be found HERE.
Present for this Meeting:
- Senator Judy Amabile (D), Chair
- Representative Kyle Brown (D), Vice Chair
- Representative Carlos Barron (R) (departed at 6:00 pm)
- Senator Jeff Bridges (D) (joined the meeting at 10:50 am; departed at 5:07 pm)
- Senator Lisa Frizell (R) (departed at 5:07 pm)
- Representative Lindsay Gilchrist (D)
- Senator Barbara Kirkmeyer (R) (departed at 5:30)
- Senator Kyle Mullica (D)
- Representative Emily Sirota (D) (participating remotely)
- Representative Rick Taggart (R)
I. Call to Order and Opening Remarks
Senator Amabile started the meeting by acknowledging that members of the Commission want to start identifying solutions. She asked Commission members to approach today’s meeting with a focus on solutions. Representative Brown added that the problems with Medicaid sustainability are dire and that the Commission is in a no-win situation. Members are faced with “choosing the least worst options.” He added that all members of the Commission are committed to finding the best solutions for a sustainable Medicaid system in Colorado.
II. Department of Health Care Policy and Financing and Office of State Planning and Budgeting Presentation
Mark Ferrandino, Director of the Office of State Planning and Budgeting (OSPB), and Gretchen Hammer, Executive Director of Health Care Policy and Finance (HCPF), presented to the Commission. Director Ferrandino began by sharing an examination of overexpenditures for fiscal year 25-26 (FY25-26) and a preliminary forecast for FY26-27 and FY27-28 expenditures. Click HERE for the slides for this section.
HCPF overspent its FY25-26 budget by $157.9 million. Colorado is not unique in this overexpenditure for FY25-56. The largest area of overexpenditure was Medical Services Premiums ($200 million). Largest areas of underexpenditure were Other Medical Services (-$27 million) and Office of Community Living (-$24.3 million).
Growth in Medicaid expenditures for FY25-26 was +$159 million / +2.8 % compared to FY24-25. Forecasts continue to show significant growth in General Fund expenditures for FY26-27 (+$443 million / +7.7%) and FY27-28 (+$918 million / +16.1%). The state is not seeing a growth in enrollment, but rather a growth in usage. Overall, the percentage of the state’s General Fund spent on HCPF and Medicaid has grown significantly since 2020. This is an unsustainable trajectory for the state. Nationally, Colorado is among states with the highest growth rate in percentage of General Fund spending on Medicaid. Within HCPF, Behavioral Health, Community-Based Long-Term Care, and the Office of Community Living are where Colorado has seen the highest rates of increased expenditures since 2018.
Members of the Commission asked Director Ferrandino several clarifying questions. The Governor’s office will submit its suggestions for spending cuts as a part of the proposed budget it submits to the Joint Budget Committee (JBC) at the beginning of November. Director Ferrandino stated that the cuts will focus on the areas of highest growth. Senator Amabile closed this section of the meeting by stating that the Commission intends to look at solutions broadly, for the entire Medicaid system in Colorado, not just for the areas of highest growth. In particular, she added, Community-Based Long-Term Care and the Office of Community Living serve those who are the most vulnerable in our state. Representative Taggart added that the General Assembly must also consider measures of outcomes as it works to identify where cuts should be made.
III. Where Things Stand
HCPF Executive Director Hammer began her presentation to the Commission. Click HERE for the slides that Hammer used. Her focus was examining growth in Medicaid program expenditures between FY20-21 and FY25-26. She identified three areas with the most growth: Acute Care Services (+ $3.0 billion / + 54%; increase largely driven by pharmacy expenditures), Behavioral Health (+ $733 million / + 93%), and Community-Based Long-Term Care (+ $2.5 billion / + 124%). Hammer identified that to some extent, Colorado has seen growth in these areas because of changes in state policy and intentional changes in expenditures. (See slide 3). Nationally, other states are experiencing growth in the same areas of care. Hammer stated that HCPF “takes accountability for the cost growth and responsibility for the previous year overexpenditure and the forecasted increased expenditure in this fiscal year.” She went on to say that HCPF is committed to working collaboratively with the General Assembly and stakeholders to create solutions to ensure sustainability.
Hammer presented an overview of HCPF’s $157.9 million General Fund overexpenditure for FY25-26. (See slide 6) and the projected budget shortfall of $1.03 billion ($442.5 million in General Fund) for FY26-27. Senator Kirkmeyer asked for a deeper examination of some areas of overspend and a look at the costs of lawsuits which have not been included in this analysis. Hammer stated that they will get deeper into some areas during this presentation and that she will have HCPF staff prepare information on the costs of lawsuits for the Commission. Representative Mullica stated that the numbers provided by HCPF to him at different times and in this presentation today are not adding up. He stated that he is also frustrated by the projections for cost increases in FY26-27 caused by forecasting errors by HCPF.
Hammer stated that these increases remain as projections, and that HCPF needs to take action today to reduce these costs. HCPF staff members are already starting to create action plans for cost savings in four areas:
- Driving administrative efficiencies
- Aligning benefits and services to maximize impact and value
- Ensuring program integrity and fiscal accountability
- Maximizing federal and non-general fund resources.
Hammer spent some time explaining preliminary plans for each area. (See slides 8-25.) The Commission spent some time discussing the plans. Highlights of this conversation include conversation about pharmacy benefits and rebates. Pharmacy costs continue to rise although the percentage of pharmacy rebates paid to the state continue to drop. The remainder of pharmacy rebates go to the federal government. Specialty drug costs, which are substantial and growing, are difficult to predict.
Senator Kirkmeyer asked for the dollar amount that HCPF is anticipating saving on the various areas of the action plans. Executive Director Hammer answered that these figures are not yet available. HCPF anticipates having them by the next Commission meeting and will present them. Hammer stated that her intention today was to get some direction from the Commission on the action plans and then bring the figures to the next meeting.
Senator Kirkmeyer asked Director Ferrandino about any direction that the former HCPF Executive Director received from the Governor’s office about projected savings that have not materialized. Director Ferrandino stated that the Governor’s office has spent much time discussing various concerns about the former Executive Director, though not to a level that was sufficient to resolve the concerns.
Director Ferrandino left the meeting at 11:50 am.
Within Behavioral Health, the areas that have had the most growth are Peer and Support Services, Residential Substance Use Disorder (SUD), and Outpatient Psychotherapy. Hammer stated that HCPF is focused on slowing these areas of cost growth within Behavioral Health. Senator Kirkmeyer emphasized the need for accurate fiscal notes when the General Assembly considers funding new programs. In 2021, the bill authorizing Peer and Support Services had a fiscal note that anticipated a General Fund expenditure of $35,000. In FY24-25, the General Fund expenditure for these services was close to $150 million. Amabile added that the Commission ought not seek to cut entire programs but rather make sure that programs are adequately serving people and are well-regulated.
IV. Long-Term Services and Supports (LTSS) Presentation
Bonnie Silva, Director of the Office of Community Living at HCPF joined Executive Director Hammer to present to the Commission. In this presentation, Silva and Hammer presented an overview of a series of fact sheets on Long Term Services and Supports (LTSS) to the Commission. (Click HERE for the fact sheets covered during this presentation.)
SIlva began by reviewing the scope and size of LTSS in Colorado. Approximately 100,000 people in Colorado are on Medicaid waivers that include LTSS. All LTSS recipients have a disability that requires a level of care that, if not for the LTSS provided, would necessitate them to live in an institutional setting. Silva also explained how LTSS fit into the suite of services that are available to Medicaid recipients in Colorado, how individuals qualify for waivers and LTSS, and how the state provides services (agency-based, in-home support services (IHSS), and consumer directed attendant support services (CDASS)). Silva gave two hypothetical examples of LTSS recipients to show the different services they would receive.
Colorado has made significant investments into its LTSS system. As a result, Colorado scores 5th overall for LTSS performance and has increased the percentage of LTSS members receiving services in community settings from 78% to 84%. A good deal of the increases in costs of LTSS to Colorado can be attributed to this growth in enrollment. Senator Amabile asked Silva to identify the driver of this growth. Silva stated that it is not one single factor. Some growth can be attributed to expanded options for family caregivers and some to increased awareness of the availability of LTSS through waivers.
Cost for LTSS has grown along with enrollment and increases in usage. LTSS now accounts for 48% of the General Fund spend for Medicaid and serves approximately 8% of the Medicaid population. Although HCPF is implementing sustainability actions, costs for FY26-27 are expected to exceed the budgeted amount by $245 million. The primary drivers of this increase include higher participation in:
- Personal Care and Homemaker Services under Community First Choice (CFC
- Community Connector
- Long Term Home Health
- Enrollment.
Senator Amabile asked Silva to assess the efficacy of the cuts to Medicaid that the General Assembly made last session. Hammer responded that we are only in the third month of this fiscal year. It is too early to make any assessment of the cuts, though HCPF is monitoring these cuts very closely. Silva continued and added that projections of increased costs are due to growth outpacing projections, particularly for homemaker services for EBD waiver recipients and personal care services for children’s waivers. Silva attributed much of this growth to implementation of Care First Choice (CFC) and providers marketing to members. HCPF has just passed rules prohibiting these marketing behaviors.
Silva shared that HCPF is working on developing an action plan for cost savings and is currently engaging in stakeholder outreach as a part of developing this plan. Silva updated the Commission on implementation of cuts made during the last legislative session. These include provider rate reductions, homemaker limits, community connector reductions, HCBS soft caps, weekly caregiver caps, and PETI for DD waiver recipients.
Hammer concluded this section of the meeting by acknowledging that HCPF is committed to both the short-term actions discussed today and longer-term sustainability measures that the Commission and General Assembly adopt. Both are a necessary component of ensuring Medicaid sustainability for Coloradans. Hammer identified six key areas to consider for longer-term redesign of Colorado’s Medicaid system:
- Eligibility & Enrollment
- Benefit & Service Design
- Utilization & Authorization
- Provider Reimbursement
- Delivery System & Care Models
- Provider Participation, Accountability, & Quality
V. Families and Advocates Panel
A panel of family caregivers and advocates presented to the Commission. These included Nicole Bishop, Margaret Williams, and Charlene Wiley. Ms. Bishop began the presentation and shared how she is able to live independently through the waiver buy-in program. Ms. Williams shared her experiences as a family caregiver for her son Christopher, who is on an EBD waiver. She emphasized the self-determination that CDASS has provided to acquire care for Christopher. Ms. Wiley shared her experiences as a caregiver for her daughter who participates in the waiver buy-in program. Commission members concluded this section by asking several clarifying questions of the panelists.
VI. Case Management Agencies and Providers Panel
A panel made up of representatives of case management agencies and providers presented to the Commission. Panelists included Matt VanAuken, CEO of Developmental Pathways; Victoria Stewart, Area Vice President of Operations, Aveanna Home Healthcare; Dr. Cassie Littler, Director, Webb Pediatric Specialty Clinic, Denver Health; and Jodi Walters, CEO of Imagine!, a HCBS provider.
Mr. VanAuken began the presentation and shared that the 15 case management agencies in Colorado serve all 100,000 individuals in the state who receive LTSS, and process over 2 million billable actions per year for those members. All transactions are fee-for-service and must be processed individually. Only 17–20% of intake work results in payments to these agencies. VanAuken stated that from his perspective, most stakeholder engagement of members by state agencies is perfunctory. He would like to see members being given a stronger voice in the system that provides their own care, and a stronger unified leadership structure for HCPF. He also shared that systems and processes are unnecessarily complex and misaligned, which complicates the case management process and is burdensome to members. The 15 case management agencies in the state have been meeting and are putting together a list of recommendations to share with the Commission.
Ms. Walters then gave her presentation and began by stating that providers want to work with the Commission to ensure a sustainable Medicaid system for the state. She shared that payments for Medicaid services are highly complex and result in hundreds of payment structures, rates, and procedures. Provider rates are not simple pass-through payments.
There are no separate administrative payments to provider agencies, although administrative requirements are highly complex. Administrative overhead rates must be evaluated against the functions and risks taken on by the provider agency. Walters’ recommendations to the Commission focused on simplifying the entire system. The complexities of the system have costs to members, providers, and agencies, and reduce our capacity to provide a high level of care to all.
Dr. Littler stated that she and pediatricians from across Colorado are committed to working with the Commission to ensure high-quality care for the state’s most vulnerable children. For pediatricians that serve children with complex health needs, the work of caring for the child extends well beyond the time of the office visit. Doctors do not receive compensation for this time outside of clinic visits. Reducing complexities in the system and supporting high-quality care coordination would help to reduce the burden on families and doctors.
Ms. Stewart emphasized that the state needs to have a singular comprehensive assessment tool to ensure that members’ needs are addressed in a coordinated and efficient manner. She added that care coordination is needed to ensure that all providers work efficiently and within regulatory boundaries. Providers must be paid adequately so agencies can maintain a competent network of providers across the state. Stewart stated that personal care services were not available through children’s waivers prior to the switch to Community First Choice. CFC made these services available for these waivers, which amounts to a policy change. The policy change resulted in the growth of delivery and cost of personal care, not targeting and marketing by providers.
The Commission asked questions of the panel. Senator Frizzell asked Mr. VanAuken to cite some examples of perfunctory stakeholding by state agencies. He said that redesign of case management system included conversation that sounded more like, “We are going to do this…” rather than “What should we be doing?” Case management agencies and members need a seat at the table when solutions are developed, not after they are chosen.
Senator Kirkmeyer asked panelists if any of their organizations were owned by a private equity firm. Aveanna Home Healthcare is owned by a private equity firm. Kirkmeyer then asked Ms. Stewart if Aveanna collects 50 percent overhead and if other private equity-owned agencies do so as well. Stewart stated that Aveanna does not collect that much and their margin is very slim; she declined to speak on behalf of other agencies. Ms. Walters added that most provider agencies are in this work for the right reason. She supports the newly established provider accountability rules. Mr. VanAuken said that provider agencies that are comprehensive and provide benefits and training to their staff are a very different thing than those that are not comprehensive. Those that are not comprehensive should be paid at a different rate.
Senator Kirkmeyer stated that changes resulting in savings over time won’t solve our needs right now. She said that immediate cuts are needed and asked the panel to consider what a freeze or discontinuation of Community First Choice would mean for providers and families. Mr. VanAuken said that this cut would be catastrophic for some families and mediocre for others.
Representative Taggart requested that Director Bonnie Silva continue to engage in deep stakeholding even as the Commission continues its work. The voices of providers and members are key to the Commission’s work, though the Commission does not have the time in its meeting schedule to hear from all stakeholders as well as needed.
Representative Brown asked Ms. Walters to go into more detail on one of her ideas for simplifying case management. Walters stated that HCPF is held publicly responsible for all LTSS, although other state agencies carry out some services. Right now there is no clarity when departments are at odds on what a member needs. A clearer line of authority would better serve members and result in efficiencies.
Senator Frizzell asked Dr. Littler to explain how we can better judge any positive results of early preventative care for children. Justifying the cost of these services will help the Commission in its decision-making. Dr. Littler agreed that early prevention of some things, like heart health, may not be apparent for years and years. Things that are more readily apparent include Kindergarten readiness, on-time graduation from high school, etc. These indicators are valid.
Senator Amabile asked the panel to consider duplication and inefficiencies in care coordination that may exist. Dr. Littler answered and said that she agrees with this concern. She feels that care coordination is best when it is provided upon request of the family or member. Amabile continued to ask for an explanation of what is attractive about Medicaid for provider agencies when margins are so slim or non-existent. Stewart stated that the most reputable agencies are creative and work to adjust withing ever-changing boundaries. Some agencies, however, are more likely to take advantage of the system and members. Dr. Littler added that there are opportunities for agencies and providers to make money off of the Medicaid system. Many choose not to maximize their profit in pursuit of providing the care that members need. A focus on documenting the outcomes for members would help to better distinguish which providers and agencies are better serving members.
Representative Taggart stated that he would like to be better informed about care coordination. In recent years, HCPF has added substantial funding for care coordination, but the General Assembly has not received information that documents the cost savings realized by this investment. Dr. Littler said that care coordination is vital to families seeking care for their children across many agencies and providers.
Senator Kirkmeyer stated that the Commission needs to hear where cuts can occur, rather than people telling them that their own program is the most important and merits saving. She asked for more people to come forward to suggest cuts. She asked if the state can end Community First Choice for people who are not on waivers. Mr. VanAuken replied that he cannot make recommendations for cuts because his organization is contracted by the state to provide services. He recommends that advocates, families, organizations, and HCPF come to the table to suggest cuts. The Office of Community Living is currently working on completing this sort of stakeholding and will be bringing recommendations to the Commission at a later date.
VII. Committee Discussion
The next Commission meeting is scheduled for October 7. The topics covered in this meeting will include:
A deep dive on Behavioral Health
Hearing from some counties about immediate sustainability measures
Discussion of the Action Plan that HCPF presented today and longer-term sustainability measures, though in a more structured format.
VIII. Public Testimony
The Commission heard testimony from 31 individuals. These included providers and representatives of provider agencies; representatives of advocacy organizations, including ADVOCACYDENVER Executive Director Pamela Bisceglia and Arc of Colorado Executive Director Elizabeth Moran; Medicaid members, including waiver recipients and buy-in members; parents; family caregivers; and representatives of associations. Topics covered included:
- CHASE funds
- Family caregiver soft caps
- PETI for DD waiver recipients
- Calls HCPF accountability and the need for an independent audit of HCPF
- Extension of the Commission’s work beyond December 2026
- Avoiding additional service cuts to those with IDD
- PASA fees
- Preserving the Medicaid buy-in program
- Equity in program cuts measured by impact on individuals rather than dollars
- Health First Colorado buy-in rates
- HCPF integrity and accountability
- Streamlining processes and cutting out the agencies in the middle
- Provider rates.
IX. Close
Senator Amabile adjourned the meeting at 6:49 pm.
Policy Perspective is a publication of ADVOCACYDENVER. If you have any questions, please contact Paul Baumann, Policy Outreach Specialist, at pbaumann@advocacydenver.org or 303.974.2535.